Friday, September 2, 2011

RoTaTiOn 2 - POH

Posted by Melanie at Friday, September 02, 2011

For my second rotation, I am in Mott Children's Hospital on the pediatric oncology/hematology (POH) unit with preceptor Dr. Erika Howle.

So far, a typical day involves working up the patients I have been assigned, rounding with the team, and attending boot camp. That's right.... boot camp!

Boot camp is a two week long introduction to oncology that takes place for two hours every afternoon. Tuesday = Pain; Wednesday = Nausea/Vomiting; Thursday = Neutropenic Fever. During these sessions, the P4s on POH are joined by the P4s on Adult Hem/Onc and Gyn/Onc. These sessions are very informative and cover topics that are commonly seen on rotation.

Friday I had a topic discussion with my preceptor about Sickle Cell.

I also have to document notes on my patients in TheraDoc, as well as interventions I have been involved with. For this documentation, I am required to become familiar with the protocol that my patients are receiving, which can be found at It is important to become familiar with the protocols so that you are able to make sure the patient is receiving the correct therapy for that day.

For example, the following is a treatment protocol for Hodgkin Lymphoma:

Drug/Dose/BCCA Administration Guideline
DOXOrubicin/25 mg/m2 on days 1 and 15/ IV push
vinBLAStine/ 6 mg/m2 on days 1 and 15/ IV push
Hydrocortisone/ 100 mg on days 1 and 15/ IV in 50 to 100 mL NS over 10 to 15 min
Bleomycin/ 10 units/m2 on days 1 and 15/IV in 50 mL NS over 15 minutes
Dacarbazine/ 375 mg/m2 on days 1 and 15/ IV in 250 to 500 mL NS or D5W over 1 to 2 hr

The protocol will also indicate which toxicities will likey occur with each drug and when therapy might need to be dose adjusted or omitted. For example:

Hepatotoxicity: DOXOrubicin only
Bilirubin (mmol/L) Dose Modification
2-35 100%
35-85 50%
greater than 85 Omit DOXOrubicin. Substitute cyclophosphamide 375 mg/m2

The protocols will also indicate what supportive therapy should be initiated. For example, antiemetics or PCP prophylaxis.

Overall, this week has been challenging, dealing with three unfamiliar subjects: oncology, hematology, and pediatrics. However, I have learned and great deal and even got to observe a bone marrow biopsy!

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